CommercialBilling CodesMedium impact
08.01.73k, Filgrastim (Neupogen®) and Related Biosimilars, and tbo-filgrastim (Granix®)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross added HCPCS code Q5172 (filgrastim-laha/Filkri biosimilar) to policy 08.01.73k effective 10/01/2026, while removing unclassified drug codes C9399 and J3590. Filkri is classified as a nonpreferred filgrastim product requiring documentation of contraindication, intolerance, or inadequate response to preferred biosimilars (Zarxio or Nivestym) for coverage.
Action Required
By September 15, 2026: Billing team must update billing system and EMR templates to recognize Q5172 (filgrastim-laha/Filkri) as a nonpreferred filgrastim product under policy 08.01.73k. Remove codes C9399 and J3590 from active billing options. Configure system to flag Q5172 claims requiring prior authorization documentation of: (1) contraindication or intolerance to preferred products filgrastim-sndz (Q5101/Zarxio) or filgrastim-aafi (Q5110/Nivestym), OR (2) inadequate response to preferred products. Train billing and prior authorization staff on new coverage requirements. Update provider communication materials to reflect Filkri as nonpreferred requiring step-therapy documentation. Claims submitted without required documentation will be denied.